Ppt chapter 35

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Hypothalamic and Pituitary
Agents
Chapter 35

Endocrine System
• Main function is to maintain homeostasis
• Too much or too little glandular activity
– Disrupts homeostasis
– Leads to various disorders
– Interferes with the normal functioning of other
endocrine glands

Hypothalamic Releasing Factors With
Diagnostic Functions
• CRH
– Stimulates release of ACTH from anterior pituitary
– Used to diagnose Cushing’s disease
• Gonadorelin (Factrel)
– GnRH analog
– Checks for anterior pituitary response and
gonadotropin deficiency

Hypothalamic Releasing Factors With
Diagnostic Functions (cont.)
• TRH (Protirelin)
– Stimulates the pituitary to produce thyrotropin,
which stimulates the thyroid to produce thyroid
hormones
• GHRH (Sermorelin)
– Stimulates the production of growth hormone (GH)
by the anterior pituitary

Hypothalamic Releasing Factors Used to
Treat Diseases and Their Actions
• Goserelin (Zoladex)
– Analog of GnRH; inhibits pituitary gonadotropin
secretion with a resultant drop in the production of
the sex hormones
• Histrelin (Supprelin), Ganirelix (Antagon), and Abarelix
(Plenaxis)
– GnRH agonists; inhibits gonadotropin secretion and
decrease the levels of steroid sex hormones

Hypothalamic Releasing Factors Used to
Treat Diseases and Their Actions (cont.)
• Leuprolide (Lupron)
– Occupies pituitary GnRH receptor sites so that they
no longer respond to GnRH
• Nafarelin (Synarel)
– A potent agonist of GnRH; decreases production of
gonadal hormones by repeated stimulation of
receptor sites

Site of Action of Hypothalamic and
Pituitary Agents

Anterior Pituitary Hormones and Their
Indications
• Chorionic Gonadotropin (Chorex): Hypogonadism,
ovulation, prepubertal cryptorchidism
• Corticotropin (Acthar), or ACTH: Test adrenal function
and responsiveness
• Cosyntropin (Cortrosyn): Diagnose adrenal dysfunction
• Menotropins (Pergonal): Fertility drug
• Somatropin (Nutropin, etc.): Growth failure, Turner’s
syndrome, AIDS, growth hormone deficiency

Anterior Pituitary Hormones and Their
Indications (cont.)
• Somatropin rDNA origin (Zorbtive): Short bowel
syndrome
• Thyrotropin (Thytropar): Diagnostic agent to evaluate
thyroid function
• Somatrem (Protropin): Treat children with growth failure

Anterior Pituitary Hormones
• Actions
– Somatropin is a hormone of recombinant DNA origin
that is equivalent to human growth hormone
• Indications
– Used in patients experiencing growth
• Pharmacokinetics
– Injected and reaches peak in 7 hours
– Widely distributed in the body
– Excreted through urine and feces

Anterior Pituitary Hormones (cont.)
• Contraindications
– Known allergy
– Allergy to ingredients in the drug
– Presence of closed epiphyses
– Underlying cranial lesions

Anterior Pituitary Hormones (cont.)
• Adverse Reactions
– Inflammation
– Swelling and joint pain
– Hypothyroidism and insulin resistance

Question
Please answer the following statement as true or false.
Somatropin is a hormone of recombinant DNA origin that is
equivalent to human growth hormone.

Answer
True
Rationale: Somatropin replaces human growth hormone;
stimulates skeletal growth, growth of internal organs,
and protein synthesis.

Growth Hormone Antagonists
• Actions
– Is an inhibitory factor released from the
hypothalamus
– Not used to decrease GH
– Has multiple effects on many of the secretory
systems
• Indications
– Treatment of acromegaly
– Varies depending on the drug

Growth Hormone Antagonists (cont.)
– Known allergy
• Caution
– Pregnancy or lactation
– Presence of any other endocrine disorder
– Varies with each medication

Posterior Pituitary Hormones
• Indications
– Treatment of neurogenic diabetes insipidus
– Desmopressin is also indicated for the treatment of
hemophilia A and von Willebrand’s disease
– Nocturnal enuresis
– Rapidly absorbed and metabolized
– Excreted in the liver and kidneys
– Not used during pregnancy due to the risk of uterine
contractions

Posterior Pituitary Hormones (cont.)
– Known allergy
– Severe renal dysfunction
• Caution
– Known vascular disease
– Epilepsy
– Asthma
– Pregnancy
– Lactation

Posterior Pituitary Hormones (cont.)
– Water intoxication
• Related to the shift in water retention
– Stimulation of GI tract
– Local nasal irritation
– Hypersensitivity

Use of Hypothalamic and Pituitary Agents
Across the Lifespan

Prototype Hypothalamic Releasing Factors

Prototype Hypothalamic Releasing Factors
(Contiuned)

Prototype Anterior Pituitary Hormones –
Growth Hormone, Agonist

Growth Hormone, Antagonist

Growth Hormone, Antagonist (Continued)

Nursing Considerations for Anterior
Pituitary Hormones – Growth Hormone
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Nursing Considerations for Posterior
Pituitary Hormones
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Question
The nurse is caring for a 10-year-old boy with growth
hormone deficiency. The child asks the nurse how long
he will be able to take his medicine. Which of the
following is best response?
A. Until you decide to stop
B. Until you are 13
C. Until your epiphyseal plates close
D. Until you get as tall as you want to be

Answer
C. Until your epiphyseal plates close
Rationale: In normal growth and development growth
ceases when the epiphyseal plates fuse to the ends of the
long bones.

Ppt chapter 35

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